From the Guidelines
After an ERCP, patients should receive routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after the procedure to prevent post-ERCP pancreatitis, as recommended by the European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) 1.
Post-ERCP Care
The care after ERCP involves several key components to ensure patient safety and prevent complications.
- Rest for the remainder of the day and avoid driving or operating machinery due to sedation effects.
- Resume a normal diet gradually, starting with clear liquids and advancing as tolerated.
- Mild throat soreness is common and can be managed with lozenges or warm salt water gargles.
- Take prescribed medications as directed, which may include antibiotics to prevent infection or pancreatic enzyme supplements.
Monitoring for Complications
It is crucial to monitor for signs of complications, which may include:
- Severe abdominal pain
- Fever above 101°F
- Vomiting
- Difficulty swallowing
- Black or bloody stools These symptoms could indicate pancreatitis, infection, or bleeding and require immediate medical attention 1.
Additional Precautions
In addition to the routine administration of NSAIDs, patients at high risk for post-ERCP pancreatitis should be considered for the placement of a 5-Fr prophylactic pancreatic stent 1.
Follow-up
Follow-up appointments are essential to discuss findings and any additional treatment needed. Most patients can return to normal activities the day after the procedure, but should avoid strenuous exercise for 2-3 days.
From the Research
ERCP Aftercare
- ERCP is a complex procedure with a high risk of adverse events, including post-ERCP pancreatitis, bleeding, perforation, infection, and cardiopulmonary events 2
- The overall adverse event rate for ERCP is typically reported as 5-10% 2
- Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective in preventing post-ERCP pancreatitis, with a risk reduction of 49% 3
- A single rectal dose of indomethacin or diclofenac before or immediately after ERCP is safe and prevents procedure-related pancreatitis both in high-risk and unselected patients 3
Prevention and Management of Adverse Events
- Protocol-based management of post-ERCP pancreatitis has been shown to be effective in reducing the severity of disease, length of hospital stay, and need for imaging studies and antibiotics 4
- Preprocedure and intraprocedure risks should be assessed, and appropriate risk-reducing modalities, such as prophylactic pancreatic stent placement and rectal indomethacin, should be used if patient or procedural factors suggest an increased risk of post-ERCP pancreatitis 5
- Clinical practice guidelines for post-ERCP pancreatitis recommend careful selection of patients, assessment of risk factors, and use of preventive interventions such as NSAIDs and pancreatic stent placement 6
Key Considerations for ERCP Aftercare
- Patients should be closely monitored for signs of adverse events, including pancreatitis, bleeding, and perforation 2
- NSAIDs should be considered for prevention of post-ERCP pancreatitis, especially in high-risk patients 3
- Protocol-based management of post-ERCP pancreatitis can help reduce the severity of disease and improve outcomes 4